Quantifying the urban environment: A scale measure of urbanicity outperforms the urban–rural dichotomy

The rapid urbanization of the developing world has important consequences for human health. Although several authorities have called for better research on the relationships between urbanicity and health, most researchers still use a poor measurement of urbanicity, the urban–rural dichotomy. Our goal was to construct a scale of urbanicity using community level data from the Cebu Longitudinal Health and Nutrition Survey. We used established scale development methods to validate the new measure and tested its performance against the dichotomy. The new scale illustrated misclassification by the urban–rural dichotomy, and was able to detect differences in urbanicity, both between communities and across time, that were not apparent before. Furthermore, using a continuous measure of urbanicity allowed for better illustrations of the relationships between urbanicity and health. The new scale is a better measure of urbanicity than the traditionally used urban–rural dichotomy.